REGIONAL- A leading indicator of COVID community activity has dropped significantly in recent weeks as Minnesota is experiencing a respite from the usual autumnal spike in cases seen in earlier years of the pandemic. However, waning immunity, low uptake of the new booster shot, and a new, more-infectious COVID virus variant are factors that could contribute to another rise in cases as winter approaches.
In late September, the viral load of COVID in northeast Minnesota wastewater treatment plants, including the Central Iron Range Sanitary Sewer District facility in Chisholm, was more than 34 times higher than in late June, and COVID hospitalizations rose right along with that. But those numbers began trending downward on Sept. 29 and has dropped dramatically since then, falling to about one-tenth of the numbers seen earlier this fall.
That mirrors a trend occurring across the country, as the Centers for Disease Control reports an equally dramatic decline beginning in late August. Significantly, CDC reports of COVID test positivity, emergency room visits, hospitalizations and deaths have also fallen from their July/August surge.
“Right now, we should remember these days what it was like before the pandemic, because that’s what we’re experiencing right now,” said noted University of Minnesota epidemiologist Michael Osterholm in a recent podcast. “They will change. Surely, we will see more stressful days ahead. But from this perspective, with the respiratory illnesses that we worry about, the ones that can hurt us and kill us, we’re in pretty good shape. Right now, in the United States we are experiencing really the lowest level of serious respiratory disease in our communities than we have probably at any time in the last five or six years. Fortunately, we’re seeing COVID numbers come down.”
Possible surge?
Despite the current COVID respite, there are reasons health experts are concerned about the possibility of a resurgence of the virus in coming months.
The first is the fact that community-wide immunity is falling as people are farther removed from their latest vaccination or COVID infection. Thoughts about herd immunity from the virus, which is long-term resistance to a virus, like that from measles and polio vaccines, has been dismissed by experts as something that will not occur with COVID, as infections and reinfections have occurred regularly as the virus has mutated.
And very few are up to date on their COVID shots. According to the Minnesota Department of Health, only 8.9 percent of St. Louis County residents are up to date with the new COVID booster approved in August, barely higher than the 8.7 percent state average. Even lower levels of booster uptake have been reported for Koochiching, Itasca, Lake, and Carlton counties. Cook County, which has had historically higher vaccination rates in comparison to the rest of the state, is only marginally better at 13.4 percent. Given that vaccine-based immunity begins to fade three months after a shot has been received, those who received their last shot prior to July are at increased risk for contracting the virus and the serious complications that can come from it.
“Vaccines, as we’ve talked over and over again for COVID, are not going to keep you from ultimately getting infected,” Osterholm said. “They will protect you for a limited period of time, but in fact, you can greatly reduce your risk of serious illness, hospitalizations, and death, even in the older age population, by getting your dose of vaccine.”
Osterholm encouraged people to not delay in getting their booster shots as he talked about the most recent clarification from the CDC in what certain groups should receive.
“Last week, the CDC’s Advisory Committee on Immunization Practices recommended a second 2024-25 COVID-19 vaccine dose, spaced six months apart for people aged 65 and older, and younger people with immunocompromising conditions,” Osterholm said. “The recommendation replaces a vaguer additional doses language that was used in an earlier recommendation for the latest COVID-19 vaccines and will likely be welcomed by those who are confused by the previous recommendation.”
Meanwhile, a new threat is the latest COVID variant, dubbed XEC. The CDC estimates that XEC represents 18 percent of the current COVID variants circulation in federal Region 5, which includes Minnesota, and it appears to be more effective in eluding immunity than any prior variant. The XEC variant is on a trajectory to become the dominant variant in the U.S. just in time for winter, when COVID-19 infections and hospitalizations tend to peak
“This is a new variant unlike any we’ve seen before based on where the mutations are,” Osterholm said. “It still is in that same lineage of viruses for which we’ve been vaccinating against, and so I do expect the vaccine to actually still be as effective here as it was with some of the other variants. What’s very different here, however, is the speed at which it likely can spread through the population. It will get around the immune protection that we may have enjoyed in the past with our vaccines or previous infections. So, at this point, I will say the take home messages is, number one, the XEC variant is going to potentially mean more transmission in the community. Those who haven’t been vaccinated recently, who haven’t been infected recently, boy, I sure urge you to go and get your booster as soon as you can.”
Long COVID
With the COVID pandemic now more than halfway through its fifth year, more and more research has been emerging about long COVID, which is not a specific condition but rather a host of different effects that can impact various body systems for months and even years after an infection.
“There isn’t a one long COVID,” Osterholm said. “We’re finding that there are multiple different long-term impacts that occur, and they can be very different. And some of us have one, some of us have another.”
Shortness of breath, chronic coughing, severe fatigue, and brain fog are some of the most widely recognized long COVID symptoms in the general public, but they can be far broader in scope, affecting sleep, sensory perception, the heart and cardiovascular system, the gastrointestinal system, and mental health, to name but a few.
A study published last week in JAMA Network Open reported seven specific symptoms that long COVID patients are at greater risk for, including loss of smell, loss of taste, rapid heart rate upon standing, problems with thinking, bone pain, mild fatigue, and severe fatigue.
What appears to be linking these wide-ranging symptoms to long COVID is the tissue inflammation that comes along with a COVID infection.
“The inflammation piece has played a huge role,” Osterholm said. “The body gets turned on, it doesn’t shut off or shut down. And then as a result, we see these other health conditions. When you look at where we’re at today in the research, what we’re really looking at is what does this inflammation do, this immune response to the host that gets turned on because of its interaction with the COVID virus.”
Osterholm cited recent research from the United Kingdom in which MRI scans were used to assess brain inflammation following severe COVID.
“The researchers found that those who were hospitalized with severe COVID had inflammation in their brainstem, which is often referred to as the control center of the brain,” Osterholm said. “Those who had longer hospital stays, more severe acute infections, and worse functional outcomes were more likely to have greater inflammation. Understanding the role of inflammation and how we might modulate it is a really important step to eventually developing therapies that can help patients right now.”